Comment: infection antedating autoimmunity-- shared mechanisms in the brain?

Area of Science:

• Neurology
• Immunology
• Infectious Diseases

Background:

• Anti-NMDA receptor (NMDAR) encephalitis is a treatable autoimmune neurological disorder.
• Ovarian teratomas are common triggers in women due to ectopic neuronal antigen expression.
• Distinguishing NMDAR encephalitis from other encephalitides can be challenging.

Purpose of the Study:

• To present a unique case of NMDAR encephalitis following HSV encephalitis.
• To emphasize the importance of considering NMDAR encephalitis in recurrent neurological episodes.
• To highlight diagnostic challenges in differentiating autoimmune and infectious encephalitides.

Main Methods:

• Case report analysis.
• Review of clinical presentation, diagnostic workup, and treatment response.
• Differential diagnosis considerations between HSV encephalitis and NMDAR encephalitis.

Main Results:

• A patient experienced a second episode of neurological dysfunction initially presumed to be related to HSV encephalitis.
• Subsequent investigations confirmed the second episode as NMDAR encephalitis.
• This case underscores the potential for co-occurrence or misdiagnosis between infectious and autoimmune encephalitis.

Conclusions:

• NMDAR encephalitis can present after or be mistaken for HSV encephalitis.
• Timely and accurate diagnosis is crucial for effective immunotherapy in NMDAR encephalitis.
• This case emphasizes the need for a broad differential diagnosis in patients with recurrent neurological symptoms.